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Van Nuys

By Andrew Horn | June 10, 2020

15243 Vanowen Street Van Nuys CA 91405
16300 Roscoe Blvd Van Nuys CA 91406
6265 Sepulveda Blvd Van Nuys CA 91411
6410 Van Nuys Blvd Van Nuys CA 91401

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
Address 2:
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Company DOT Name:
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Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
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Owner Operator:*
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* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
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- Basic Package ($100)
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  - Paper CCFs or Electronic CCFs
  - $60 Drug Test / $50 Breath Alcohol
- Compliance Package ($300)
  All Benefits of Basic Package plus:
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  - DOT Policy
  - Required Supervisor Training
  - Part 40.25 Form (Required for all drivers)
Optional Add On
*
- 2 Additional Years of Enrollment ($100)
- Part 40.25 Form ($25)
- Supervisor Training ($50/each)
- Paper Copies of 49 CFR Part 40 & 382 ($25)
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- No Additional Add-Ons = $0.00
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Add all columns on front and back on this form.
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